A Clinicopathological Study of Leiomyoma Variants of the Uterus

Objectives To estimate the prevalence of histological fibroid variants in a cohort of women undergoing surgery for presumed fibroids and to study the clinical characteristics of this cohort. Materials and Methods From January 2014 to December 2017, records of patients who underwent a surgery for benign gynaecological indication with presumed fibroids were identified from the operation theatre database for a 4-year period. The complete histopathological reports for each case were taken from pathology result database. Out of these, the reports suggestive of leiomyoma variants were identified. The total number of histologically proven cases of leiomyomas variants was 56. Results The mean age was 41.9 years (SD 9 years). The most common presenting symptom was abnormal uterine bleeding in 53.5% of cases. Hysterectomy was done in 58.9%, and myomectomies were performed in 41.4%. Of the total leiomyoma variants, 60% ( n = 34) were cellular leiomyoma, 19.6% ( n = 11) were mitotically active leiomyomas (MAL),14.3% ( n = 8) were leiomyomas with bizarre nuclei (LBN), and 5.4% ( n = 3) cases were reported as smooth muscle tumour of uncertain malignant potential (STUMP). Infarction-type necrosis was seen in 3 cases, and a coagulation-type necrosis was seen in 2 cases of STUMP. Forty-one patients were available for follow-up. Forty patients were disease-free on follow-up. Conclusions Most behave in a benign fashion, and follow-up without adjuvant therapy is currently recommended. Critical evaluation of coagulative tumour necrosis is essential. Follow-up remains a challenge in our setting.